局部神经阻滞麻醉对腹股沟无张力疝修补镇痛效果及应激反应影响的前瞻性随机对照研究

目的对比局部神经阻滞麻醉与硬膜外麻醉在无张力疝修补手术中镇痛效果及应激反应的影响。方法选取文昌市人民医院2018年6月至2019年6月诊治120例腹股沟疝患者资料。按随机数表法将所有患者分为对照组和研究组,各60例。给予对照组患者硬膜外阻滞麻醉,给予研究组患者局部神经阻滞麻醉。记录2组患者的卧床时间、住院时间、术后疼痛评分、应激反应指标、并发症等情况。结果研究组卧床时间、住院时间较对照组明显缩短,差异有统计学意义(P<0.05);2组患者的术后疼痛评分差异无统计学意义(P>0.05);研究组白介素-6、肿瘤坏死因子-α与C反应蛋白等应激指标较对照组明显降低,差异无统计学意义(P<0.05);研究组围手术期尿潴留、呕吐恶心发生率与对照组相比明显降低,差异有统计学意义(P<0.05);2组患者的复发率、感染率、慢性疼痛发生率,差异无统计学意义(P>0.05)。结论腹股沟无张力疝修补手术局部神经阻滞麻醉与硬膜外麻醉效果相当,但能缩短住院时间和术后卧床时间,对机体应激反应的影响较小,围手术期并发症发生率低。

Analgesic effect and stress response of inguinal tension-free inguinal hernia repair under local nerve block anesthesia:A prospective randomized controlled study

Objective To compare the analgesic effect and stress response of local nerve block anesthesia and epidural anesthesia in tension-free hernia repair.Methods The clinical data of 120 patients with inguinal hernia diagnosed and treated in Wenchang People's Hospital from June 2018 to June 2019 were enrolled and divided into two groups according to the random number table.The control group(n=60)was given epidural block anesthesia,and the study group(n=60)was given local nerve block anesthesia.The operative related indicators,postoperative pain score,stress response indicators and complications were analyzed in both groups.Results The bed time and hospital stay in the study group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative pain score between the two groups(P>0.05).Stress indexes such as IL-6,TNF-A and CRP in the study group were significantly lower than those in the control group(P<0.05).The incidence of perioperative urinary retention,vomiting and nausea in the study group was significantly reduced compared with the control group,and the differences were statistically significant(P<0.05).There were no significant differences in recurrence rate,infection rate or incidence of chronic pain between the two groups(P>0.05).Conclusion Local nerve block anesthesia for inguinal tension-free inguinal hernia repair has the same effect as epidural anesthesia,but it can shorten the hospital stay and postoperative bed time,and it has less influence on the stress response of the body and lower perioperative complication rate.